Vaccinating the unreached at a faster speed
Not only have vaccination waiting times reduced, the setting up a UNICEF supported cold chain point in Nagri block in Ranchi is making sure all mothers and children are getting vaccinated
RANCHI, India- Most of us have been to a health centre for vaccination, for COVID-19 or for routine immunization. The process involves us arriving at the centre, waiting, receiving the jab and leaving, with some of us occasionally complaining about service delays.
But have we ever wondered what goes on behind the scenes? Or the difficulties that accompany it? Patients visiting the public health centre (PHC) in Ranchi's Nagri block were most likely unaware of the reason for the delays in the vaccination process.
For a long time, the Nagri PHC struggled to be efficient, and one of the prominent reasons was the lack of a cold chain point.
"We've experienced a shortage of human resources since Nagri became a new block. We had to send our staff to the far-off Ratu block to obtain the vaccine. This travel time also risks the vaccine's potency because temperature stability is critical, says Dr Ratan Purnima Toppo, Medical Officer in Charge of the PHC.
"At times, the PHC would receive the vaccine as late as 11:00 AM, arrive at the PHC between 12:00 and 1:00 PM, and then distribute them to various vaccination centres. The children at the vaccination sites in rural areas would suffer. For women mothers involved in agriculture, they would avoid waiting for a long time and invariably choose to leave the vaccination centre instead," adds Dr Toppo.
The delays at the centre would also prompt mothers to move from one PHC to another in search of vaccines. This would lead to delayed vaccination and immunization dropouts.
However, adding a new cold chain point has transformed the PHC. It has improved the routine immunization process and the PHC's overall efficiency. "The introduction of the cold chain facility has significantly altered the situation. People are now getting the vaccine at their site itself. Human resources are also being used more effectively," said Dr Ratan with a smile.
This was the result of rigorous assessment and advocacy by UNICEF. "According to Government of India guidelines, no vaccine should take more than one hour to reach the farthest centre. Previously, the vaccine took more than 1.5 to 2 hours to arrive at centres close to the Nagri PHC from the Ratu CHC.
In 2018, UNICEF and partners identified Nagri PHC as one of the critical points where cold chain presence could be expanded. " This was part of the Government of India guidelines and to strengthen the immunization supply chain," says Dr Vanesh Mathur, Health Officer at UNICEF Jharkhand.
"Our staff used to travel long distances on motorcycles, carrying four to five boxes, which was a difficult task for them. Now it is convenient for ANMs from nearby areas to take the vaccine, which also helps them save on travel time. In the past, people would wait hours in the summer for routine immunizations, leaving their work at home or in the office. Now it barely takes them 10-15 mins," says ," says Sushma Manjula Lakra, the Cold Chain Handler at the Nagri PHC.
Robust immunization supply chains are a prerequisite for Full Immunization Coverage (FIC) and equity, contributing to improved maternal and child health. The immunization supply chain includes the people, activities, and infrastructure necessary to ensure vaccine safety and effectiveness. Efficient management of the entire immunization supply chain is vital to ensure the availability of all vaccines at the right place, time, and in optimal condition.
Patients, too, have noticed the change. "My child is one-and-half year old. I have had my child regularly vaccinated at this PHC following the immunization schedule. Previously, I had to wait for a long time, but now the vaccine is administered quickly. The PHC is now better equipped, and the difference is visible," said Chunmun Devi, a resident of Kathal More in Ranchi.
UNICEF conducts periodic Effective Vaccine Management (EVM) assessments to check the status of cold chain points and storage units. This assessment considers the functionality, space assessment and enhancement for cold chain point expansion. The availability of skilled HR and their training requirements is also considered for the assessment. These EVM assessments entail a four-step approach: assess, plan, implement and monitor, which repeats in a cycle of continuous learning and innovation.
"Way back in 2016-17, we conducted the EVM assessment. That assessment gave us a real insight into how the cold chain system within the state is working. As part of the Action Plan, we identified centres where additional cold chain points would be required to reduce the travel time of the vaccine. Following this, we installed an Ice Lined Refrigerator (ILR) and one deep freezer at the Nagri PHC," said Dr. Mathur.
The cold chain's activation took a while and the non-availability of equipment and trained manpower, together with the pandemic, posed a big hurdle. At the end of 2020, a new cold chain point at the PHC was created through UNICEF's advocacy with the district RCH (Reproductive and Child Health) officer and the civil surgeon.
Furthermore, as the state of Jharkhand's key capacity-building partner, UNICEF also worked to strengthen the capacity of Cold Chain Handlers in all districts. Sushma Manjula Lakra, the Cold Chain Handler at Nagri PHC, is among the 400 Cold Chain Handlers trained by UNICEF Jharkhand.
UNICEF has consistently supported the immunization programme by focusing on vaccine management and expansion of cold chain systems, backup support to immunization centres, procurement of substituted power equipment such as solar equipment, and monitoring and managing information systems.
UNICEF plays a significant role in assisting the State Government in ensuring full immunization coverage by identifying missed out children, enrolling them in the duelists, supporting the immunization supply chain, and training the Cold Chain Handlers.
